[Chaunce1234]

This is an interesting question, given that a c-section is a significant abdominal incision.

The anatomy is indeed very different though, not just because male/female, but because of the area being sutured and repaired. I think with a hernia repair you are stitching tissue together that is not normally together thereby rebuilding the inguinal region, whereas with something like a c-section you are suturing tissue back together that was always together to begin with. I don’t know if it’s that simple, and I could be entirely wrong.

Anyway, an interesting question regardless, it would be great to hear from a surgeon as to their thoughts on this matter.

[Chaunce1234]

Out of curiosity… where is your pain and what is it like? How long have you been in pain for? Do you know for certain the pain is from the hernias? Are they direct or indirect hernia? One side, or both sides?

Reported no mesh hernia surgeons in the western USA include the following, be sure to verify directly yourself because some of this is second/third hand information, or gathered from comments on various internet discussion forums:

– Dr Paul Dally in Vancouver, Washington (unconfirmed)

– Dr Robert Martindale in Portland, Oregon

– Dr Michael Mastrangelo in Bend, Oregon (unconfirmed)

– Dr William Brown in Fremont, California

– Dr Shirin Towfigh in Los Angeles, California

– Dr David Chen in Los Angeles, California (unconfirmed)

– Dr Edward Phillips in Los Angeles, California

– Dr Robert Burns in Newport Beach, California

– Dr Kevin Petersen in Las Vegas, Nevada

– Dr John Etlinger in San Antonio, Texas (unconfirmed)

– Dr Zafar Parvez in Albuquerque, New Mexico

There are likely others as well, but they are increasingly hard to find.

Frequency and familiarity with the no mesh hernia repair procedures is critical because it is an anatomically complex region and the classic tissue repair procedures are quite complicated.

Also, your own body matters too. Most no-mesh hernia repairs have to be done on patients with a normal or reasonable BMI, as being too overweight can make the procedure less effective.

As far as “non mesh laparoscopic repair” that is going to be difficult, but Dr Shirin Towfigh in California apparently offers a solution in that regard. I am not aware of any technical details about it however. You also may be able to find a surgeon willing to perform a simple Marcy repair or pediatric style laparoscopic repair without mesh if it is an indirect hernia, but most surgeons would probably consider that as experimental on an adult.

As [USER=”1176″]Momof4[/USER] mentioned Dr Andrew Wright at U Washington Seattle may be a helpful resource with referrals, but I believe he himself is only a laparoscopic mesh surgeon, possibly the same with his colleague Dr Allison Perrin, though I could be wrong.

Also, keep in mind these aren’t necessarily recommendations, they’re just said to be surgeons willing to perform the hernia repair procedures without using mesh.

Anyway, best of luck. Keep us updated on your case, decision making, and progress.

[Chaunce1234]

Did you ask the surgeon if it’s possible to remove the two tacks that are located where the pain is? If they’re located at the site of pain, perhaps that’d make some sense.

Are you male/female? Did you have any pain before surgery? What was the original complaint that led to the surgery?

[Chaunce1234]

Related, a big documentary called “The Bleeding Edge” is about to come out on the $400 billion medical device industry with vaginal mesh as a primary topic. It’s not clear if it will include references to hernia mesh…

https://www.hollywoodreporter.com/review/bleeding-edge-1105081

[Chaunce1234]

Does the region of the fluid collection coincide with the region of your symptoms? Perhaps you could sit with the radiologist or a surgeon and have them point out exactly where on your body the fluid collection is, and see if that aligns with where you have pain or discomfort? Just a thought.

[Chaunce1234]

If you’re feeling better, have no pain or other annoying symptoms, and a surgeon told you it is safe to ignore it, I would probably ignore it, but that’s just me as a fellow patient.

Keep in mind that groin hernia surgery in general now has as curiously high risk of chronic pain and so it’s not a risk-free procedure, thus the potential benefit must outweigh that risk.

I recall reading that a direct hernia and femoral hernia are sometimes confused on ultrasound, so that is a possibility too.

A second opinion may be helpful for various reasons and for peace of mind, what region are you located? Perhaps someone could recommend a nearby expert for you to consult with.

[Chaunce1234]

The “Minimal Repair” by Dr Muschaweck is usually used for inguinal disruption / sports hernia type injuries, I am not sure if applies to a regular inguinal hernia. I believe she performs a Shouldice repair for a typical inguinal hernia.

There are supposedly two or three surgeons in the USA who perform the same repair as Dr Muschaweck for sports hernia injuries – Dr Boyarsky in NJ and Dr Litwin in MA, here is a brief article from Boyarsky discussing the injury:

https://www.rbmc.org/do-i-really-hav…thlete-hernia/

You’d have to reach out to those surgeons and ask them if the same procedure would apply to an inguinal hernia.

“Fascia transversalis repair” to me sounds like it’s describing half of a Shouldice repair, but I am not a surgeon and don’t know enough about the anatomy to assess that.

A Shouldice repair from Shouldice has very good results so it likely remains one of the top options for a mesh-free repair if someone is eligible for it and able to travel to Canada.

Dr Kang on these forums appears to have developed a unique mesh free hernia minimal repair technique with great results as well, but he is based in South Korea so the distance may be impractical for some patients.

With the indirect hernia, there is also the Marcy repair which is usually performed on kids and youth, but some doctors swear it works fine on adults too if the hernia isn’t too big yet and the patient is not obese. There is also a variation which is laparoscopic and does not use mesh, but you’d have to find a surgeon willing to try it on an adult. Obviously there is some debate here.

A direct hernia I think requires repairing the actual floor of the inguinal canal, because it has torn through for whatever reason. I don’t know if that is entirely accurate, but I think it’s accurate-ish.

Desarda repair might qualify as “minimal” to some regard since it’s using your owe muscle as a flap to cover a hernia, whether that makes someone prone to recurrence where the muscle was borrowed from, I don’t know.

Anyway that’s about it for my knowledge, but do share with us what you find, what you hear, and what you decide on.

[Chaunce1234]

Shouldice in Toronto is well known and a great choice for hernia surgery, but as you said they will only do surgery based on a palpable hernia.

I wonder if, under doctor supervision of course, you could try and make the hernia appear through valsava or some other effort? Was the ultrasound done with valsava?

Have you ruled out any other possible causes/problems in the region? Anything GI or digestive going on?

I have read anecdotal reports of people “managing” small hernias with physical therapy, so if a doctor approved it that may be a reasonable interim action while you wait anyway.

[Chaunce1234]

quote inguinalpete:

Physical exam and ultrasound – no hernia. They want to do a CT scan to see if the mesh is folded/balled. You say a 3D MRI may be of use?

The 3T MRI is basically a higher resolution MRI than the standard 1.5 T, the T stands for Tesla which is the measurement for the strength of the magnetic field generated by the MRI machine itself. The contrast injection may or may not matter, I think contrast usage depends on the tissue and structures being evaluated, but often MRI is done both with and without contrast to fully image various structures.

A CT scan may be valuable too, hopefully a doctor on these forums can chime in with their opinion on that or the most appropriate imaging study for your case.

And as [USER=”1176″]Momof4[/USER] points out, getting proper interpretation of imaging is critical. A lot of radiology interpretation is outsourced nowadays which means that often nobody who sees you personally is going to look at the images, they just write up a report and send it out as the diagnosis. Further adding to the frustration of imaging studies, is that some radiologists don’t alway note hernias, sports injuries, athletic pubalgia, or mesh, or even know how to look for those, unless something is extremely obvious. And of course it’s possible that something wouldn’t show up on imaging anyway.

Regardless, after you get your imaging done, make sure you get a copy of it on a disc so that if you need/want to, you can send it to various experts for direct interpretation. Nearly all of the doctors in the list above will review images directly.

[Chaunce1234]

I’m sorry you’re going through this.

Did the surgical wound dehisc and open on it’s own? Was there an infection? Is the nurse having to pack it to let heal from the inside out?

I’m not a doctor, but my assumption is that any future procedure would likely be delayed until the existing wound has completely healed, and then they would reassess for an umbilical hernia and/or incisional hernia. Of course that may not apply if the mesh itself is part of problem and in need of replacement, but an experienced hernia surgeon should be able to give you proper insight into this.

What part of the country / world are you located in? Perhaps a regional expert can be recommended to assist you.

[Chaunce1234]

I’m a fellow patient, not a doctor, but….

quote :

When attempting to use my core to do a sit-up type movement or leg adduction (e.g. squeezing a pillow in between your legs) I can feel pain.

To me that is a giant flag that you may have an athletic specific injury. Pain with resisted sit-ups and adduction are often classic symptoms of athletic pubalgia or another core muscle injury.

Have you tried resting the injury for a few weeks / months, or is that not an option?

Did the 5mm inguinal hernia found on ultrasound say if it was direct or indirect? And what the herniating tissue was? Was it reducible?

Where specifically is your pain? Is it at the muscle attachment point on your pubic bone, or in the inguinal region, or adductor attachment, or testicle, or the lower abdominal muscles, or none or all of the above?

The good news is you’re located on the east coast, and Washington DC is just a two hour train ride from one of the premiere sports injury facilities in the world at Vincera Institute in Philadelphia. They routinely do work on professional athletes and have a great track record for diagnosing and resolving a wide variety of complex athletic problems of the pelvis, abdomen, hip, and groin, including athletic pubalgia, inguinal hernias, adductor issues, nerve entrapment, and much more.

Sports hernia / inguinal disruption / athletic pubalgia experts:

– Dr William Meyers, at Vincera Institute in Philadelphia PA 267-592-3200

– Dr Alexander Poor – Vincera Institute, Philadelphia PA 267-592-3200

– Dr Demetrius Litwin – UMass MA 508-334-0661

– Dr Brian Busconi – UMass MA

– Dr Andrew Boyarsky – NJ 732-360-3520

– Dr William Brown – Fremont CA 510-793-2404

– Dr Ulrike Muschaweck – Munich Germany / London UK

I believe most of the aforementioned surgeons perform no-mesh surgical repairs for athletes when possible, inquire with them directly to learn why they use that method.

Depending on your insurance and the clinic / doctor / practitioner / facility / etc you may need to pay some costs out of pocket.

Most of the aforementioned surgeons are quite reachable and communicative, and are more than happy to respond to inquiries and general questions. Whether it’s the 5mm inguinal hernia or a sports hernia or another issue entirely, they will almost certainly be able to diagnose it and give you more information along with treatment plans.

Anyway, best of luck. Keep us updated on your case, progress, and decision making.

[Chaunce1234]

Interesting, that is good to know!

[Chaunce1234]

Have you had any imaging done yet that could help diagnose?

Some potentially revealing imaging studies that are frequently discussed on these forums:

– ultrasound with valsava at location of pain

– 3T MRI (with or without contrast, contrast shows different tissues I think)

Keep us updated on your case and progress.

[Chaunce1234]

What was the surgery type? Was it open or keyhole laparoscopic? Mesh or no mesh? Inguinal hernia or other?

You’re a few weeks out from the surgery, but I suspect it’s normal to have some swelling and discomfort if it was an open repair.

If you’re concerned about any particular symptom, reach out to your GP for a sooner appointment, otherwise I would let your body heal and let how it feels guide you, along with the GP advice of course.

[Chaunce1234]

Fair question, perhaps you could ask Dr Petersen if he has a reference or two to speak with?

Have you already been diagnosed with a hernia, or do you just suspect it based on symptoms?

Did Dr Petersen offer any particular opinion or thoughts about his surgical approach for an athletic patient?

[Chaunce1234]

Based on what I have read on these forums, I believe an umbilical hernia situation is easier to deal with than an inguinal hernia problem, so that’s good news. But it’s also possible that it’s not the problem at all, so tell your friend to be open minded.

A few ideas:

– Has your friend tried an elimination diet to see if there is any reaction, resolution, or worsening from particular foods?

– Have they tried probiotics and similar to try and help normalize gut bacteria?

– Have they been to a GI specialist to rule in/out any particular issues? The C-diff history makes that worth pursuing if it hasn’t been already.

– Has your friend had blood work done to check for any abnormal inflammation or inflammatory markers?

As for the hernia, if your friend is thinking of having the mesh removed and then a tissue repair (if possible) that is likely why doctors would suggest he lose weight. Many non-mesh practitioners recommend being in the ‘normal’ BMI weight range for the repair to hold, and I think that being overweight increases general risk of hernia and recurrence in general. The elimination diet may help lose weight as well. Often just reducing or eliminating things like junk food, soda, carbohydrates, etc can lead to notable weight loss, and some people report less inflammation in general after they’ve cut out some of those foods.

C-diff can be pretty serious to deal with too and it’s conceivable there is some lingering GI issue, so it’s worth at least ruling that out. Imbalanced or poor gut bacteria can do strange things and cause strange symptoms. On that note, some patients report wildly successful GI symptom resolution with a fecal transplant – yes really a feces transplant, and I believe there is some research to show it can cure C-Diff as well.

My opinion as a mere patient is that if a problem can be cured without surgery, then cure it without surgery. So if possible, rule in/out other things first.

Keep us updated on the case and any progress.

[Chaunce1234]

Here is a description of sports hernia of the “inguinal disruption” variety:

quote :

“Abnormal tension exists in the inguinal canal due to varying degrees of ID [Inguinal Disruption] and this is recognised as posterior wall weakness, external ring dilation, conjoint tendon damage and tears in the inguinal ligament. Not all of the features are present in any one individual and other pathologies involving the muscles, ligaments and joints may also be affected.”

And potential diagnosis:

quote :

“The diagnosis of ID can be made if at least three out of the five clinical signs below are detectable

1. Pinpoint tenderness over the pubic tubercle at the point of insertion of the conjoint tendon;
2. Palpable tenderness over the deep inguinal ring;
3. Pain and/or dilation of the external ring with no obvious hernia evident;
4. Pain at the origin of the adductor longus tendon; and
5. Dull, diffused pain in the groin, often radiating to the perineum and inner thigh or across the midline.”

From the British Medical Journal:

http://bjsm.bmj.com/content/early/2013/12/10/bjsports-2013-092872

[Chaunce1234]

How long have you had symptoms? Was there an event that brought the symptoms on suddenly?

If it is not particularly painful or interfering in your daily life much, and approved by a doctor/surgeon, using the “watchful waiting” method seems reasonable. Many surgeons take the approach of “no palpable bulge = no hernia” so that also may be why they’re telling you to wait.

Where are you located? Perhaps someone could recommend a regional expert near to you.

[Chaunce1234]

Not in Chicago, but this may be helpful:

– Dr David Grischkan in Cleveland, Ohio

– Dr Paul Szotek in Indianapolis, IN

– Dr Bruce Ramshaw in Knoxville, TN

– Shouldice clinic in Toronto Canada is somewhat nearby

[Chaunce1234]

quote active_runner:

Thanks for all of the input!

[USER=”1916″]Chaunce1234[/USER] I did talk with Dr. Brown about the cremaster muscle. He said that since I am fairly lean that it’s likely that the muscle is not bulky and that he will not need to remove much if any of it. I have no idea how accurate this is though.

[USER=”2520″]Topochico[/USER] the “tailored repair” is my description. I asked him how he determines which open non-mesh repair to use (he describes the various options on his website). He indicated that it depends on the type of hernia, the size, the quality of the tissue, etc. Based on this he will choose a method, or a hybrid approach. Interestingly, he indicated that if my hernia is indirect that the solution is quite simple. Unfortunately I think mine are direct. Good point about asking how he would treat chronic pain. I can’t find much of anything about him in regards to standard inguinal hernia surgery. It appears that he is an accomplished sports hernia doc and considering that those repairs are in the same location and often in the same tissues, I have to imagine that would translate.. Does that seem reasonable to you?

[USER=”935″]drtowfigh[/USER] I am trying to avoid mesh. I’m young enough and lean enough that the long term effects scare me and the more I read the more I think this fear is very rational. I read somewhere that you do a lap procedure using natural tissue, is that true?

Thanks for the added info. Any idea what Dr Browns recurrence rate has been with his tailored approach?

If you are not sure if the hernias are direct or indirect, often an ultrasound valsava can reveal that information.

You could always ask the Dr directly if you can speak to any former patients, I am not sure if that is allowed due to HIPAA privacy laws but it may be worth a shot.